WEBVTT
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Hi, I'm Wendy Zuckerman, and you're listening to Science Versus
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from Gimlet Media. This is the show where we pit
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facts against foreskins. On today's show, circumcisions. To snip or
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not to snip? So how many circumcisions do you reckon
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you've performed?
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That's a good question. I think you could say more
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than a thousand.
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That's a lot of willies.
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Well, yeah.
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And the man trimming all those willies is Dr Andrew Friedman,
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a paediatric urologist at Satus Sinai Medical Centre in Los Angeles.
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And when it comes to circumcisions, Andrew has heard it all.
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He's heard from anxious parents who don't know what to do,
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grown men who wish they still had their foreskins, and
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even teens struggling with their bodies. He told us about
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this one teenager who came to him asking to get
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cut because the other guys at school were teasing him
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for being uncircumcised. And Andrew was like, dude, it's not
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about the foreskin.
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They're teasing you. They're not going to stop teasing you
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if you have a circumcision.
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Did you really tell him that?
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Yeah, because I do believe that. And he was the
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kind of kid who's kind of an awkward kid, a
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little socially awkward. I mean, like, he's the kid who's
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going to get teased, and it's unfortunate, but... He didn't
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need to change his body. It wasn't like the kids
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were going to say, oh, wow, now you're a really
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cool guy because now your penis looks like my penis.
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Come over to my house and we'll play football, you know?
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It's just life doesn't work that way.
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Okay, so Andrew doesn't think a circumcision will save you
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from bullies, and he's spent a lot of time thinking
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about this. Several years ago, Andrew was asked to help
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write a review for the American Academy of Pediatrics, weighing
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up the pros and cons of circumcisions. And some people
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think there are a lot of cons. In fact, there's
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a group of people called intactivists. And they say it's
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better to leave the penis as it is.
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In other words, intact.
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They argue that this surgery is totally unnecessary. And it's cruel.
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After all, you're taking a healthy baby and then cutting
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off a part of them.
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People wrap up a lot with their penis. And I
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have received thoughtful letters from adult men saying, who feel
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like something was taken away from them and are really angry.
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So, do these intactivists have a point? And if you're
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a parent trying to make this decision for your baby,
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what are you supposed to make of all this? To
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find out, we are entering the foreskin firestorm ourselves and asking... One,
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what are the risks of getting a circumcision?
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Could it hurt the baby? Two, what are the benefits.
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Can it prevent infections like UTIs or more serious stuff
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like HIV? And three, as weird as it is to
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think about your baby growing up and having sex, we
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have to ask, could this affect his sex life? And yes,
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there are religious and ethical questions about circumcision. But I'm
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a science journalist, not a rabbi. So today, we're focusing
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on the scientific questions. Because when it comes to circumcisions...
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There are lots of willies.
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Well, yeah.
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But then there's science. Science vs Circumcision is coming up
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just after the break.
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Welcome back.
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So....
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People have been cutting off foreskins for ages, millennia even,
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all around the world. But in the United States, circumcisions
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didn't become widespread until around the turn of the 20th century,
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where some doctors began to promote it as a sort
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of cure-all for all kinds of health problems. They even
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said it would stop boys from masturbating. But where there's
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a willy, there's a way.
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By the 1970s, though, more and more people started questioning...
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Why are we doing this?
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And today, fewer and fewer parents are choosing this for
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their kids. According to the most recent stats from the
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Centers for Disease Control, around 40% of baby boys born
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in the US didn't get circumcised. And in some parts
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of the country, intact boys are actually in the majority. So,
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did these kids dodge a bullet? Our first question for today...
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What are the risks of this surgery? Because lopping off
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a baby's foreskin sounds pretty scary. Andrew, our pediatric urologist,
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told us that one common device you can use.
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Sort of looks like a cigar cutter.
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Yeah, a cigar cutter. Here's how it works.
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The foreskin is separated from the head of the penis,
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pulled forward.
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And.
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Then you clamp it down and you basically just cut
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straight across.
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The way that circumcisions are done with this like cigar
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cutting tool, like you would think that like a lot
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could go wrong often.
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You know, it seems like there's like.
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A little penis and a little foreskin and then you
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have a sharp knife near it all.
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Can you cut off the penis? Okay.
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Having been in practice for 20 years, I've seen this
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three times in 20 years.
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And in all of those cases, the penis wasn't lopped off.
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It had just been clipped a little. Did you do
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it those three times?
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No, no, no, no, no, no, no, no.
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Andrew says he was called in to fix these mistakes.
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And he says that these cases.
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Are, of course, awful. But they're also very uncommon.
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It's a bad thing. It shouldn't happen. But I'll acknowledge
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it happens, but it's very, very rare.
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And the data backs up Andrew.
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A recent paper looked at almost one and a half
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million circumcisions and found three cases of clipped penises. There
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are other risks like bleeding and infections, but overall, the
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risk of a serious complication is less than half a percent.
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Andrew does acknowledge, though, that this isn't fun for babies.
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Is it painful for a baby to get a circumcision?
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Yes.
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It is painful. People just need to be honest about this.
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It's painful.
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Andrew says the pain can be managed with a local anaesthetic.
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So for the most part, it's thought to not be
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a big deal.
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Conclusion.
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In terms of the immediate risks for your baby boy,
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a circumcision can hurt, but the serious stuff is extremely rare. Still,
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why risk it at all? What are the potential benefits
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of cutting off the foreskin? Well, that brings us to
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our second question. Can circumcisions reduce the risk of getting
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an infection? With the foreskin on, there's this idea that
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the flappy bit makes a nice home for the gunk
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in your junk. Get rid of the flappy bit, get
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rid of the gunk. In truth, it's more complicated. It's
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not like it's necessarily dirty down there, but getting a
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circumcision can actually protect you from some infections. And that's
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partly because the foreskin can kind of shuffle in bacteria
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and viruses. The first time this might matter is when
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a baby is really young. Having a foreskin makes them
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more likely to get a urinary tract infection.
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And it is a real effect. Kids with foreskin had
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about an 8 to 10 times higher risk of getting
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a urinary tract infection in their first year of life.
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UTIs can be painful for the baby, and in the
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worst case scenario, the infection can spread to other parts
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of the body. Andrew told us, though, that these infections
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don't happen very often. Even if you have a foreskin,
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only about 1% of intact babies will get these infections.
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Another way to wrap your head around these stats is
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to ask, how many circumcisions do you have to do
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to stop one willy getting one urinary tract infection?
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You have to do like 100 circumcisions to prevent that
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one infection.
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That's a lot of foreskins being sacrificed to the god
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of UTIs.
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Yeah, so it meant that you had to do an
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awful lot of circumcisions to prevent every infection.
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And maybe the god of UTIs doesn't deserve our foreskins
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because these infections usually aren't that scary and healthy kids
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can be treated and recover quickly. But what about infections
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that are a lot more serious? So when these babies
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grow up and start having sex, can circumcisions protect them
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from sexually transmitted diseases like HIV?
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We talked through.
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This with another doctor, Godfrey Chigozi. Godfrey is the Director
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of Research at Rakai Health Sciences Program in Uganda, and
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he's been studying HIV and circumcisions for more than a decade. Now,
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talking to men about their penises was something that Godfrey
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never expected he would do. But now, he does it
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all the time.
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Yes, and sometimes I joke with them and say that
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I have a machine that can scan you to see
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if you're circumcised. No, I'm joking.
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Godfrey's path to studying circumcision started back in the 1990s,
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when HIV was spreading across Uganda. And it was really scary.
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Around one in ten adults in the country had the virus.
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One in ten.
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Oh, it was a terrible feeling because there was no...
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no medication that could help at all. And we really
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felt very helpless and it was so bad. It was
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so bad.
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Medicines to treat HIV did exist, but they weren't widely
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available in Uganda and scientists were desperately searching for solutions.
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Godfrey remembers this one day in the midst of the
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crisis when he was in a boardroom and another researcher said, hey, we're.
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Finding this weird thing.
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Men who have a circumcision seem to have a lower
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risk of getting HIV. And then the researcher asked, so
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to stop this disease from spreading, should we start giving
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out circumcisions?
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And, of course, everybody in the boardroom laughed because everybody
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thought he was joking.
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And why did you think it was a joke?
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It sounded weird a bit at the start. Of course,
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if there was anything that was easier to do, we
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would have taken that.
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And the reason that Godfrey would have gone for anything
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else was because he knew this was going to be
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a really hard sell. Testing the idea would mean convincing people,
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grown men, to get circumcisions. But Godfrey and his team
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must be pretty persuasive because they ended up recruiting more
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than 2,000 men to get circumcised. Then they followed them
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for two years, comparing them to a group of men
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who weren't circumcised.
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And in 2007, they published their results.
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Men who were circumcised actually had more than 50% reduction
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in chances of acquiring HIV.
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More than 50%. 50%?
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Yes.
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And what did you feel? Like, what were you thinking
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at that time when you got those results?
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Ah, my God. I was feeling like, this is it.
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The results were so impressive that researchers stopped the trial
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early because the data was so clear. Circumcisions could reduce
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a man's risk of getting HIV. At around the same time,
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two other trials in Kenya and South Africa found the
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same thing. And many public health researchers around the world
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got really excited about Godfrey's work and the other trials.
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In fact, the results of this work caught the attention
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of many U.S.
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Doctors, like our own urologist, Andrew.
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So the HIV is probably, from a world health perspective,
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the most viable benefit to be derived from circumcision.
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But for Andrew, this research on HIV in Uganda doesn't
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give him a clear answer for parents in the U.S.
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who want to know whether they should circumcise their kid
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or not.
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The question is, how does that work out in the U.S. experience?
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For a child having a circumcision today to prevent HIV,
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it's hard to tell you, like, what, you know, is that,
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in terms of saving lives, is it worth it?
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Because on average, in the U.S., many people aren't that
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likely to have sex with someone with HIV. And that
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means your circumcision has less of an opportunity to come
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to the rescue.
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This isn't true for everyone, though.
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According to data from the CDC, rates of HIV in
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the US are higher in certain communities, like men who
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have sex with men, which could mean a circumcision is
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more likely to protect you.
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But when it comes to men who have sex with men,
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things get tricky. Because here's the surprising thing.
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It's unclear whether circumcisions play an important role in reducing
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HIV infections amongst gay men. The majority of the really
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good studies that we have are in straight men. So
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that's HIV. And what about other sexually transmitted infections? Well,
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circumcisions have also been shown to help with genital herpes
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and HPV.
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It cuts the risk of having.
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Those diseases by roughly 30%. Conclusion. When it comes to infections,
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circumcisions do reduce the risk of UTIs in babies and
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they can reduce the risk of some sexually transmitted infections
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like HIV, herpes and HPV.
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So that's infections.
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But after the break, we change positions and find out
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whether circumcisions can mess up your sex life. Can snipping
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off the foreskin change the sensitivity of your penis? That's
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coming up after the break. Hey, it's Wendy from Science Versus,
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00:14:36.139 --> 00:14:38.139
and I want to tell you about a podcast that
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I love, Science Friday. They cover all sorts of amazing
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things in the weird and wonderful world of science, from
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how concussions affect our brain to the inner secrets of
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a snake with.
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A spider on its tail.
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It's a lot of news that you can use and
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some that you can't, but you're going to love anyway.
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It's hosted by Ira.
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Flato and Phyllis.
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Flora Lichtman, who is an old friend of the show
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and loves a pun as much as we do. Science
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Friday is on every day wherever you get your podcasts.
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Welcome back. So, circumcisions, they have some benefits.
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They reduce your risk of catching some infections, including sexually
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transmitted ones like HIV. But now we're going to look
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at this idea that a circumcision could make your sex
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life worse. Because for most people with penises, this organ
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plays a really important role in having good sex. And
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a circumcision is literally removing a part of the penis.
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So how could it not affect things down there? We
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asked a scientist who really knows her way around a penis.
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Hi there.
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This is Carolyn Pucall, a professor at Queen's University in Ontario, Canada,
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where she runs a lab that studies sex. And from
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early on, it was pretty clear that Carolyn was going
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to grow up to be a sex researcher.
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When I was in high school, I sort of became
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the person in the group that everyone would come to
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to talk and get advice from. And eventually it became
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sort of this kind of like, you know, let's go
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to Caroline and ask her about sex. She seems to
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know a few things.
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And as Carolyn grew up and started her career, an
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idea kept coming up that circumcisions obviously made sex worse
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for people with penises. The claim was that the skin
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at the tip of the penis, called the glands, hardens
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a bit once there's no foreskin to protect it.
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Yeah, and I mean, it just makes sense, right? The
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exposed glands penis... is going to be rubbing against underwear.
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It's exposed to all of these, like, different kinds of friction,
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like in jeans and pants. It makes sense that that
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skin would harden and there would be lower sensitivity in
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men who did not have a foreskin.
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It made sense, but Caroline didn't just want to assume
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it was true.
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People were like, well, you know, Caroline. I was like,
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I actually don't know that. And I thought to myself,
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if I ever get my own research lab, I would
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like to examine this.
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Carolyn, of course, now has her own research lab. So,
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she thought, time to get to the bottom of this.
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Here's what Carolyn and her colleagues did. They got about
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60 men, half circumcised at birth and the other half
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still intact.
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And then the fun, I mean, the experiment, could begin.
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Carolyn and her team had a variety of ways of
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measuring whether the circumcised penis was actually less sensitive.
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Than the uncircumcised.
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One involved prodding penises with these poking devices.
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They're short, they're thick, and it's like bristles on a brush.
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Then she pushed the bristles into the head of their penises.
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So it would be like, yes, I feel that. Is
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it painful or not?
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No, it isn't.
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We'd go to the next one. Is it painful or not? Yes,
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it is. And that would be their pain threshold.
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And did you get, were men like, ouch, ouch, ouch, ouch?
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Some men were. It has a sort of an unpleasant
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kind of sharp, pricky kind of feeling to it.
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Hey, you can't do a penis sensitivity study without poking
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a few penises.
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And here's what Carolyn's team learned.
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We found that the penises overall of intact and circumcised
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men were not significantly different in terms of tactile pain,
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which was actually very, very interesting.
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Oh, wow.
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Wow.
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So the head of the penis, that bit that spent
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all those years rubbing against underwear and whatnot, it was
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just as sensitive in the circumcised men as it was
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in those who still had their foreskins.
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We were really surprised. We were really, really surprised.
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And although this was just one study, we did find
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two other research papers that saw the same thing. No
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difference in the penis's sensitivity. In fact, the only study
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that we did find that reported a difference here was
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funded by a group that's now called Genital Autonomy America. Yeah,
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Genital Autonomy America, which is a group fighting for an
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independent autonomous nation of penises and vaginas.
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No, of course not. It's an anti-circumcision group.
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But that's not the end of the story, because Carolyn
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and her team also tested the foreskins of the intact men.
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And she found that the skin there really did respond
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to a prod.
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Or as Carolyn says.
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So the foreskin in and of itself was exceptionally sensitive
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to touch.
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Aha.
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So what does this then tell us about whether circumcision
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makes it less fun to have sex?
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Well, it certainly something is amiss. Through circumcision, the foreskin
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00:20:04.369 --> 00:20:06.910
is being removed and it is a sensitive part of
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the penis.
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And this really sounds like circumcisions might make sex worse.
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But Carolyn says, hold your horses.
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Whether that translates to sexual sensation remains to be really
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demonstrated through research.
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Carolyn's experiment was such an unsexy situation. The men were
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in a lab, they were not erect, and they were
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not having sex. And sex, Carolyn says, is about so
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much more than sensitivity you can measure with probes.
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Orgasms include more than just the genitals that are involved.
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And so it really depends on novelty. It depends on
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one's state of mind. It depends on comfort with the partner.
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It's more of a sort of a whole body experience.
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And it's not like the foreskin is sensitive in a
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way that you can't even imagine. Carolyn found it was
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about as sensitive as another part of the body, the forearm.
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00:21:00.940 --> 00:21:02.720
So if you flip your forearm kind of over, so
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you're looking at like the inside of it, we test
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about four inches below the wrist. And that area is
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just a very sensitive part of the body.
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00:21:11.390 --> 00:21:15.210
Well, I've been having sex wrong, haven't I?
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00:21:16.109 --> 00:21:20.450
We all have been. Which really speaks, I think, to,
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you know, sort of including the whole body in terms
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of sexual activity. Absolutely. It's like, don't ignore the forearm.
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Go for it.
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00:21:29.359 --> 00:21:32.400
So because sex doesn't boil down to this body part
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or that body part, Carolyn's lab study can only take
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00:21:35.940 --> 00:21:40.019
us so far. Another way to look at how circumcisions
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00:21:40.079 --> 00:21:43.319
affect sex lives is to ask grown men who have
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gotten circumcisions to describe their experiences with sex before and after.
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00:21:48.670 --> 00:21:50.190
And researchers have done this.
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00:21:50.990 --> 00:21:54.230
And on the whole, these men report that sex doesn't
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00:21:54.309 --> 00:21:59.430
change much, but everyone's experience is a little different. And
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that made us really curious to talk to some of
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00:22:02.200 --> 00:22:06.339
these men who had had circumcisions as adults. So our producer,
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00:22:06.460 --> 00:22:08.230
Rose Rimler... called up a bunch of them.
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00:22:09.690 --> 00:22:12.190
I guess, uh, tell me about your penis.
396
00:22:13.710 --> 00:22:14.170
Okay.
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00:22:14.380 --> 00:22:17.579
Something I noticed after I had it chopped off was
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00:22:17.880 --> 00:22:20.140
it was just constantly brushing up against things and it
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00:22:20.180 --> 00:22:22.880
was driving me crazy. The head is just as sensitive
400
00:22:22.940 --> 00:22:23.539
as everything else.
401
00:22:23.640 --> 00:22:27.259
It still feels great, but, um, you're missing that extra
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00:22:27.839 --> 00:22:32.099
surface area. Honestly, If a fairy met with me in
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00:22:32.140 --> 00:22:34.440
the woods now and offered me to give me the
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00:22:34.480 --> 00:22:38.900
foreskin back, I'd decline because it's been so nice.
405
00:22:39.579 --> 00:22:43.650
It's healed and it's actually totally fine. I think it's
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00:22:43.890 --> 00:22:45.490
pretty much just as good either way.
407
00:22:46.069 --> 00:22:49.150
The foreskin isn't magic, in other words. Yeah, yeah, it
408
00:22:49.170 --> 00:22:49.789
was super cool.
409
00:22:49.809 --> 00:22:50.910
It was great to have it.
410
00:22:50.910 --> 00:22:54.609
I thought mine looked all right, you know, but it's
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00:22:54.650 --> 00:22:55.269
no great loss.
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00:22:57.089 --> 00:22:59.289
To bring this to a head, a recent review paper
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00:22:59.390 --> 00:23:02.490
found that there wasn't hard evidence to support the idea
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00:23:02.569 --> 00:23:07.329
that circumcisions make sex worse for men. Certainly, millions of
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00:23:07.410 --> 00:23:12.660
circumcised men around the world still really, really enjoy sex.
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00:23:14.039 --> 00:23:17.400
That's not the case for everyone, though. During Carolyn's research
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00:23:17.480 --> 00:23:20.640
on circumcisions, she found a group of people who have
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00:23:20.900 --> 00:23:23.380
real issues with their circumcised penises.
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00:23:24.240 --> 00:23:27.029
I did come across some people who actually seemed very
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00:23:27.089 --> 00:23:30.549
traumatised by their lack of foreskin.
421
00:23:30.970 --> 00:23:33.369
Some of them told Carolyn that they were upset that
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something important to them had been removed from their body
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and they didn't have any choice in it. Some blamed
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00:23:39.470 --> 00:23:42.849
their long-lost foreskins for a lack of sexual confidence or
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00:23:42.890 --> 00:23:46.230
for their body issues. So when you put it all together,
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00:23:46.529 --> 00:23:50.130
do you think that being intact increases your chance of
427
00:23:50.190 --> 00:23:51.150
having better sex?
428
00:23:51.960 --> 00:23:52.710
Well....
429
00:23:53.920 --> 00:23:59.039
I think that it doesn't usually matter, but when it matters,
430
00:23:59.319 --> 00:24:03.240
it matters a lot. So most people with penises don't
431
00:24:03.299 --> 00:24:05.819
care about their circumcision status. They don't spend a lot
432
00:24:05.859 --> 00:24:10.069
of time thinking about it. But if their circumcision status
433
00:24:10.130 --> 00:24:13.829
does matter to them, it is part of their identity
434
00:24:14.670 --> 00:24:16.849
and it can affect their sexual pleasure in a way
435
00:24:16.950 --> 00:24:18.269
that is damaging.
436
00:24:20.059 --> 00:24:20.619
Conclusion.
437
00:24:20.880 --> 00:24:23.599
As best as science can tell, a circumcision does not
438
00:24:23.660 --> 00:24:26.920
make a penis less sensitive and it's unlikely to affect
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00:24:26.960 --> 00:24:30.809
a man's sex life in a big way. Still though,
440
00:24:30.960 --> 00:24:34.190
for a small group of men, they take their circumcisions
441
00:24:34.349 --> 00:24:37.650
really hard. And then it does affect their sex life.
442
00:24:38.930 --> 00:24:42.950
So when it comes to circumcisions, do they stack up? One,
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00:24:43.390 --> 00:24:46.509
are there risks to this surgery? Well, it can be
444
00:24:46.549 --> 00:24:49.250
painful and there can be serious complications.
445
00:24:49.809 --> 00:24:53.630
But they are very rare. Two, does it reduce your
446
00:24:53.690 --> 00:24:54.769
risk of infections?
447
00:24:55.509 --> 00:24:55.829
Yes.
448
00:24:56.390 --> 00:24:59.319
For babies, it cuts down the risk of UTIs, but
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00:24:59.500 --> 00:25:02.960
that's a rare disease anyway. And when that baby grows
450
00:25:03.119 --> 00:25:05.880
up and starts getting laid, it can reduce their risk
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00:25:06.019 --> 00:25:10.589
of HIV, HPV and herpes. Three, when it comes to
452
00:25:10.619 --> 00:25:13.009
men's sex life, does it put a damper on things?
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00:25:13.849 --> 00:25:17.190
It's unlikely getting snipped plays a huge role in sexual
454
00:25:17.250 --> 00:25:18.529
pleasure for most men.
455
00:25:20.250 --> 00:25:21.529
So what are we to make of this?
456
00:25:22.259 --> 00:25:25.720
Well, when Andrew, our circumcision guru, and his team at
457
00:25:25.740 --> 00:25:29.700
the American Academy of Pediatrics wrapped up their review, what
458
00:25:29.720 --> 00:25:30.339
did they say?
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00:25:30.960 --> 00:25:34.559
We felt that the benefits outweighed the risk enough that
460
00:25:34.579 --> 00:25:36.279
people who want it should be allowed to have it,
461
00:25:36.400 --> 00:25:39.700
should have access to it. But it doesn't have enough
462
00:25:39.819 --> 00:25:42.509
benefit to say everybody ought to have it.
463
00:25:43.039 --> 00:25:43.839
To cut to the chase?
464
00:25:44.480 --> 00:25:49.559
To be fair, the benefits are very, very modest. The
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risks are very, very modest.
466
00:25:53.460 --> 00:25:55.779
So to Andrew, either choice is valid.
467
00:25:56.380 --> 00:25:59.099
And when he had to make the decision, it actually
468
00:25:59.319 --> 00:26:01.019
wasn't about the medical benefits.
469
00:26:01.779 --> 00:26:04.180
So I have a son. My son is 14.
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00:26:04.180 --> 00:26:06.380
When he was little, did you decide to give him
471
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a circumcision?
472
00:26:07.829 --> 00:26:11.329
Yes, I did decide to do a circumcision. At the
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00:26:11.410 --> 00:26:13.190
time I did it, I didn't feel like I was
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00:26:13.230 --> 00:26:17.150
doing it as a doctor. I was doing it as
475
00:26:17.190 --> 00:26:20.630
a religious ceremony. You know, I'm a practicing Jew, and
476
00:26:20.950 --> 00:26:24.170
in our traditions, we do the circumcision on the eighth day.
477
00:26:24.650 --> 00:26:29.579
And how did you feel as a scientist that you
478
00:26:29.619 --> 00:26:33.940
were making this big decision for your son based on religion?
479
00:26:34.619 --> 00:26:38.240
You're not one thing. So I'm not a scientist 24-7.
480
00:26:38.299 --> 00:26:41.960
I mean, like all people, we're complicated. And that's why
481
00:26:41.980 --> 00:26:45.220
you have to kind of respect that it's a messy decision.
482
00:26:45.740 --> 00:26:47.420
And we want to try to make this a black
483
00:26:47.440 --> 00:26:50.640
and white decision where you just, you know, you punch
484
00:26:50.660 --> 00:26:53.269
a bunch of numbers in the computer and you spit
485
00:26:53.309 --> 00:26:56.009
out the right answer. But it's not that way. It's
486
00:26:56.049 --> 00:26:56.960
a messy decision.
487
00:26:58.190 --> 00:27:01.710
Andrew says Americans should just get used to the idea
488
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that there will be different kinds of penises.
489
00:27:04.650 --> 00:27:06.269
In fact, he envisions a.
490
00:27:06.369 --> 00:27:11.500
World, a better world, a beautiful world. where every sort
491
00:27:11.519 --> 00:27:13.640
of penis has its place in the rainbow.
492
00:27:14.019 --> 00:27:16.640
Why do all penises have to look alike? Why can't
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some people do one thing and some people do another
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and let families do what they feel is best for them?
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Someday.
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Maybe.
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Maybe.
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That's science versus circumcisions.
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Great.
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Those are our only questions. Is there anything you wanted
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to add?
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To anyone out there, if you have any comments or
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00:27:55.910 --> 00:27:59.990
concerns about anything I've said, please send your email to
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science versus....
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Sorry, there's something wrong with the connection here. We're going
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to have to leave you there.
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00:28:13.880 --> 00:28:16.089
We have a big favour to ask. If you listen
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00:28:16.119 --> 00:28:19.190
to Science Versus, even just every now and then, we'd
509
00:28:19.309 --> 00:28:21.769
love for you to fill out a survey. We want
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00:28:21.789 --> 00:28:23.809
to know what you like about the show, what you want.
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00:28:23.730 --> 00:28:26.410
More of, what you want less of. Tell us.
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Go to scienceversus.show slash survey. That's scienceversus, sciencevs.show slash survey.
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Thank you. and Bahizi Ignatius.
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For this episode, we also spoke to Dr. Jen Bossio, Dr.
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Aaron Tobian, and a bunch of folks at the CDC.
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Thank you so much.
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A special thanks to the parents and circumcised men.
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Who spoke with us for this story, as well as
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Frank Lopez, and to all my family and Joseph Lavelle Wilson.
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We're off next week, but we'll be back in two weeks,
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and then we're tackling Lyme disease.
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Should you be afraid of it?
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Physicians don't want, they don't want to go near these patients.
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The patients are regarded as lepers.
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They don't want to go near them with a 10.
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Pole.
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I'm Wendy Zuckerman. Back to you next time.
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Hi, I'm Wendy Zuckerman, and you're listening to Science Versus
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from Gimlet Media. This is the show where we pit
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facts against foreskins. On today's show, circumcisions. To snip or
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not to snip? So how many circumcisions do you reckon
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you've performed?
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That's a good question. I think you could say more
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than a thousand.
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That's a lot of willies.
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Well, yeah.
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And the man trimming all those willies is Dr Andrew Friedman,
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a paediatric urologist at Satus Sinai Medical Centre in Los Angeles.
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And when it comes to circumcisions, Andrew has heard it all.
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He's heard from anxious parents who don't know what to do,
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grown men who wish they still had their foreskins, and
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even teens struggling with their bodies. He told us about
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this one teenager who came to him asking to get
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cut because the other guys at school were teasing him
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for being uncircumcised. And Andrew was like, dude, it's not
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about the foreskin.
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They're teasing you. They're not going to stop teasing you
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if you have a circumcision.
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Did you really tell him that?
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Yeah, because I do believe that. And he was the
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kind of kid who's kind of an awkward kid, a
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little socially awkward. I mean, like, he's the kid who's
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going to get teased, and it's unfortunate, but... He didn't
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need to change his body. It wasn't like the kids
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were going to say, oh, wow, now you're a really
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cool guy because now your penis looks like my penis.
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Come over to my house and we'll play football, you know?
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It's just life doesn't work that way.
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Okay, so Andrew doesn't think a circumcision will save you
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from bullies, and he's spent a lot of time thinking
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about this. Several years ago, Andrew was asked to help
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write a review for the American Academy of Pediatrics, weighing
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up the pros and cons of circumcisions. And some people
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think there are a lot of cons. In fact, there's
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a group of people called intactivists. And they say it's
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better to leave the penis as it is.
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In other words, intact.
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They argue that this surgery is totally unnecessary. And it's cruel.
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After all, you're taking a healthy baby and then cutting
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off a part of them.
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People wrap up a lot with their penis. And I
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have received thoughtful letters from adult men saying, who feel
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like something was taken away from them and are really angry.
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So, do these intactivists have a point? And if you're
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a parent trying to make this decision for your baby,
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what are you supposed to make of all this? To
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find out, we are entering the foreskin firestorm ourselves and asking... One,
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what are the risks of getting a circumcision?
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Could it hurt the baby? Two, what are the benefits.
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Can it prevent infections like UTIs or more serious stuff
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like HIV? And three, as weird as it is to
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think about your baby growing up and having sex, we
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have to ask, could this affect his sex life? And yes,
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there are religious and ethical questions about circumcision. But I'm
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a science journalist, not a rabbi. So today, we're focusing
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on the scientific questions. Because when it comes to circumcisions...
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There are lots of willies.
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Well, yeah.
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But then there's science. Science vs Circumcision is coming up
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just after the break.
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Welcome back.
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So....
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People have been cutting off foreskins for ages, millennia even,
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all around the world. But in the United States, circumcisions
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didn't become widespread until around the turn of the 20th century,
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where some doctors began to promote it as a sort
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of cure-all for all kinds of health problems. They even
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said it would stop boys from masturbating. But where there's
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a willy, there's a way.
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By the 1970s, though, more and more people started questioning...
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Why are we doing this?
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And today, fewer and fewer parents are choosing this for
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their kids. According to the most recent stats from the
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Centers for Disease Control, around 40% of baby boys born
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in the US didn't get circumcised. And in some parts
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of the country, intact boys are actually in the majority. So,
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did these kids dodge a bullet? Our first question for today...
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What are the risks of this surgery? Because lopping off
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a baby's foreskin sounds pretty scary. Andrew, our pediatric urologist,
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told us that one common device you can use.
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Sort of looks like a cigar cutter.
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Yeah, a cigar cutter. Here's how it works.
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The foreskin is separated from the head of the penis,
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pulled forward.
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And.
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Then you clamp it down and you basically just cut
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straight across.
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The way that circumcisions are done with this like cigar
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cutting tool, like you would think that like a lot
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could go wrong often.
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You know, it seems like there's like.
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A little penis and a little foreskin and then you
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have a sharp knife near it all.
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Can you cut off the penis? Okay.
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Having been in practice for 20 years, I've seen this
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three times in 20 years.
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And in all of those cases, the penis wasn't lopped off.
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It had just been clipped a little. Did you do
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it those three times?
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No, no, no, no, no, no, no, no.
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Andrew says he was called in to fix these mistakes.
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And he says that these cases.
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Are, of course, awful. But they're also very uncommon.
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It's a bad thing. It shouldn't happen. But I'll acknowledge
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it happens, but it's very, very rare.
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And the data backs up Andrew.
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A recent paper looked at almost one and a half
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million circumcisions and found three cases of clipped penises. There
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are other risks like bleeding and infections, but overall, the
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risk of a serious complication is less than half a percent.
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Andrew does acknowledge, though, that this isn't fun for babies.
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Is it painful for a baby to get a circumcision?
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Yes.
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It is painful. People just need to be honest about this.
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It's painful.
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Andrew says the pain can be managed with a local anaesthetic.
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So for the most part, it's thought to not be
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a big deal.
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Conclusion.
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In terms of the immediate risks for your baby boy,
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a circumcision can hurt, but the serious stuff is extremely rare. Still,
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why risk it at all? What are the potential benefits
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of cutting off the foreskin? Well, that brings us to
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our second question. Can circumcisions reduce the risk of getting
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an infection? With the foreskin on, there's this idea that
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the flappy bit makes a nice home for the gunk
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in your junk. Get rid of the flappy bit, get
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rid of the gunk. In truth, it's more complicated. It's
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not like it's necessarily dirty down there, but getting a
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circumcision can actually protect you from some infections. And that's
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partly because the foreskin can kind of shuffle in bacteria
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and viruses. The first time this might matter is when
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a baby is really young. Having a foreskin makes them
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more likely to get a urinary tract infection.
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And it is a real effect. Kids with foreskin had
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about an 8 to 10 times higher risk of getting
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a urinary tract infection in their first year of life.
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UTIs can be painful for the baby, and in the
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worst case scenario, the infection can spread to other parts
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of the body. Andrew told us, though, that these infections
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don't happen very often. Even if you have a foreskin,
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only about 1% of intact babies will get these infections.
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Another way to wrap your head around these stats is
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to ask, how many circumcisions do you have to do
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to stop one willy getting one urinary tract infection?
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You have to do like 100 circumcisions to prevent that
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one infection.
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That's a lot of foreskins being sacrificed to the god
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of UTIs.
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Yeah, so it meant that you had to do an
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awful lot of circumcisions to prevent every infection.
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And maybe the god of UTIs doesn't deserve our foreskins
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because these infections usually aren't that scary and healthy kids
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can be treated and recover quickly. But what about infections
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that are a lot more serious? So when these babies
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grow up and start having sex, can circumcisions protect them
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from sexually transmitted diseases like HIV?
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We talked through.
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This with another doctor, Godfrey Chigozi. Godfrey is the Director
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of Research at Rakai Health Sciences Program in Uganda, and
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he's been studying HIV and circumcisions for more than a decade. Now,
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talking to men about their penises was something that Godfrey
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never expected he would do. But now, he does it
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all the time.
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Yes, and sometimes I joke with them and say that
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I have a machine that can scan you to see
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if you're circumcised. No, I'm joking.
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Godfrey's path to studying circumcision started back in the 1990s,
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when HIV was spreading across Uganda. And it was really scary.
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Around one in ten adults in the country had the virus.
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One in ten.
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Oh, it was a terrible feeling because there was no...
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no medication that could help at all. And we really
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felt very helpless and it was so bad. It was
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so bad.
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Medicines to treat HIV did exist, but they weren't widely
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available in Uganda and scientists were desperately searching for solutions.
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Godfrey remembers this one day in the midst of the
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crisis when he was in a boardroom and another researcher said, hey, we're.
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Finding this weird thing.
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Men who have a circumcision seem to have a lower
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risk of getting HIV. And then the researcher asked, so
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to stop this disease from spreading, should we start giving
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out circumcisions?
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And, of course, everybody in the boardroom laughed because everybody
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thought he was joking.
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And why did you think it was a joke?
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It sounded weird a bit at the start. Of course,
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if there was anything that was easier to do, we
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would have taken that.
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And the reason that Godfrey would have gone for anything
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else was because he knew this was going to be
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a really hard sell. Testing the idea would mean convincing people,
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grown men, to get circumcisions. But Godfrey and his team
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must be pretty persuasive because they ended up recruiting more
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00:11:11.990 --> 00:11:15.629
than 2,000 men to get circumcised. Then they followed them
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for two years, comparing them to a group of men
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who weren't circumcised.
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And in 2007, they published their results.
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Men who were circumcised actually had more than 50% reduction
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in chances of acquiring HIV.
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More than 50%. 50%?
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Yes.
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And what did you feel? Like, what were you thinking
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at that time when you got those results?
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Ah, my God. I was feeling like, this is it.
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The results were so impressive that researchers stopped the trial
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early because the data was so clear. Circumcisions could reduce
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a man's risk of getting HIV. At around the same time,
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two other trials in Kenya and South Africa found the
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same thing. And many public health researchers around the world
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got really excited about Godfrey's work and the other trials.
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In fact, the results of this work caught the attention
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of many U.S.
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Doctors, like our own urologist, Andrew.
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So the HIV is probably, from a world health perspective,
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the most viable benefit to be derived from circumcision.
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But for Andrew, this research on HIV in Uganda doesn't
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give him a clear answer for parents in the U.S.
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who want to know whether they should circumcise their kid
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or not.
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The question is, how does that work out in the U.S. experience?
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For a child having a circumcision today to prevent HIV,
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it's hard to tell you, like, what, you know, is that,
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in terms of saving lives, is it worth it?
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Because on average, in the U.S., many people aren't that
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likely to have sex with someone with HIV. And that
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means your circumcision has less of an opportunity to come
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to the rescue.
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This isn't true for everyone, though.
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According to data from the CDC, rates of HIV in
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the US are higher in certain communities, like men who
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have sex with men, which could mean a circumcision is
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more likely to protect you.
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But when it comes to men who have sex with men,
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things get tricky. Because here's the surprising thing.
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It's unclear whether circumcisions play an important role in reducing
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HIV infections amongst gay men. The majority of the really
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good studies that we have are in straight men. So
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that's HIV. And what about other sexually transmitted infections? Well,
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circumcisions have also been shown to help with genital herpes
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and HPV.
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It cuts the risk of having.
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Those diseases by roughly 30%. Conclusion. When it comes to infections,
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circumcisions do reduce the risk of UTIs in babies and
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they can reduce the risk of some sexually transmitted infections
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like HIV, herpes and HPV.
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So that's infections.
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But after the break, we change positions and find out
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whether circumcisions can mess up your sex life. Can snipping
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off the foreskin change the sensitivity of your penis? That's
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coming up after the break. Hey, it's Wendy from Science Versus,
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and I want to tell you about a podcast that
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I love, Science Friday. They cover all sorts of amazing
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things in the weird and wonderful world of science, from
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how concussions affect our brain to the inner secrets of
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a snake with.
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A spider on its tail.
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It's a lot of news that you can use and
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some that you can't, but you're going to love anyway.
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It's hosted by Ira.
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Flato and Phyllis.
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Flora Lichtman, who is an old friend of the show
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and loves a pun as much as we do. Science
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Friday is on every day wherever you get your podcasts.
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Welcome back. So, circumcisions, they have some benefits.
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They reduce your risk of catching some infections, including sexually
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transmitted ones like HIV. But now we're going to look
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at this idea that a circumcision could make your sex
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life worse. Because for most people with penises, this organ
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plays a really important role in having good sex. And
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a circumcision is literally removing a part of the penis.
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So how could it not affect things down there? We
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asked a scientist who really knows her way around a penis.
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Hi there.
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This is Carolyn Pucall, a professor at Queen's University in Ontario, Canada,
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where she runs a lab that studies sex. And from
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early on, it was pretty clear that Carolyn was going
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to grow up to be a sex researcher.
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When I was in high school, I sort of became
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the person in the group that everyone would come to
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to talk and get advice from. And eventually it became
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sort of this kind of like, you know, let's go
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to Caroline and ask her about sex. She seems to
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know a few things.
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And as Carolyn grew up and started her career, an
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idea kept coming up that circumcisions obviously made sex worse
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for people with penises. The claim was that the skin
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at the tip of the penis, called the glands, hardens
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a bit once there's no foreskin to protect it.
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Yeah, and I mean, it just makes sense, right? The
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exposed glands penis... is going to be rubbing against underwear.
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It's exposed to all of these, like, different kinds of friction,
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like in jeans and pants. It makes sense that that
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skin would harden and there would be lower sensitivity in
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men who did not have a foreskin.
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It made sense, but Caroline didn't just want to assume
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it was true.
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People were like, well, you know, Caroline. I was like,
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I actually don't know that. And I thought to myself,
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if I ever get my own research lab, I would
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like to examine this.
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Carolyn, of course, now has her own research lab. So,
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she thought, time to get to the bottom of this.
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Here's what Carolyn and her colleagues did. They got about
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60 men, half circumcised at birth and the other half
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still intact.
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And then the fun, I mean, the experiment, could begin.
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Carolyn and her team had a variety of ways of
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measuring whether the circumcised penis was actually less sensitive.
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Than the uncircumcised.
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One involved prodding penises with these poking devices.
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They're short, they're thick, and it's like bristles on a brush.
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Then she pushed the bristles into the head of their penises.
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So it would be like, yes, I feel that. Is
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it painful or not?
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No, it isn't.
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We'd go to the next one. Is it painful or not? Yes,
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it is. And that would be their pain threshold.
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And did you get, were men like, ouch, ouch, ouch, ouch?
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Some men were. It has a sort of an unpleasant
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kind of sharp, pricky kind of feeling to it.
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Hey, you can't do a penis sensitivity study without poking
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a few penises.
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And here's what Carolyn's team learned.
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We found that the penises overall of intact and circumcised
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men were not significantly different in terms of tactile pain,
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which was actually very, very interesting.
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Oh, wow.
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Wow.
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So the head of the penis, that bit that spent
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all those years rubbing against underwear and whatnot, it was
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just as sensitive in the circumcised men as it was
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in those who still had their foreskins.
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We were really surprised. We were really, really surprised.
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And although this was just one study, we did find
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two other research papers that saw the same thing. No
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difference in the penis's sensitivity. In fact, the only study
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that we did find that reported a difference here was
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funded by a group that's now called Genital Autonomy America. Yeah,
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Genital Autonomy America, which is a group fighting for an
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independent autonomous nation of penises and vaginas.
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No, of course not. It's an anti-circumcision group.
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But that's not the end of the story, because Carolyn
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and her team also tested the foreskins of the intact men.
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And she found that the skin there really did respond
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to a prod.
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Or as Carolyn says.
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So the foreskin in and of itself was exceptionally sensitive
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to touch.
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Aha.
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So what does this then tell us about whether circumcision
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makes it less fun to have sex?
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Well, it certainly something is amiss. Through circumcision, the foreskin
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is being removed and it is a sensitive part of
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the penis.
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And this really sounds like circumcisions might make sex worse.
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But Carolyn says, hold your horses.
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Whether that translates to sexual sensation remains to be really
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demonstrated through research.
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Carolyn's experiment was such an unsexy situation. The men were
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in a lab, they were not erect, and they were
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not having sex. And sex, Carolyn says, is about so
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much more than sensitivity you can measure with probes.
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Orgasms include more than just the genitals that are involved.
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And so it really depends on novelty. It depends on
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one's state of mind. It depends on comfort with the partner.
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It's more of a sort of a whole body experience.
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And it's not like the foreskin is sensitive in a
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way that you can't even imagine. Carolyn found it was
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about as sensitive as another part of the body, the forearm.
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So if you flip your forearm kind of over, so
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you're looking at like the inside of it, we test
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about four inches below the wrist. And that area is
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just a very sensitive part of the body.
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Well, I've been having sex wrong, haven't I?
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We all have been. Which really speaks, I think, to,
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you know, sort of including the whole body in terms
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of sexual activity. Absolutely. It's like, don't ignore the forearm.
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Go for it.
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So because sex doesn't boil down to this body part
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or that body part, Carolyn's lab study can only take
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us so far. Another way to look at how circumcisions
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affect sex lives is to ask grown men who have
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gotten circumcisions to describe their experiences with sex before and after.
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And researchers have done this.
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And on the whole, these men report that sex doesn't
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change much, but everyone's experience is a little different. And
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that made us really curious to talk to some of
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these men who had had circumcisions as adults. So our producer,
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Rose Rimler... called up a bunch of them.
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I guess, uh, tell me about your penis.
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00:22:13.710 --> 00:22:14.170
Okay.
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Something I noticed after I had it chopped off was
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it was just constantly brushing up against things and it
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was driving me crazy. The head is just as sensitive
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as everything else.
401
00:22:23.640 --> 00:22:27.259
It still feels great, but, um, you're missing that extra
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surface area. Honestly, If a fairy met with me in
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the woods now and offered me to give me the
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foreskin back, I'd decline because it's been so nice.
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00:22:39.579 --> 00:22:43.650
It's healed and it's actually totally fine. I think it's
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pretty much just as good either way.
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00:22:46.069 --> 00:22:49.150
The foreskin isn't magic, in other words. Yeah, yeah, it
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00:22:49.170 --> 00:22:49.789
was super cool.
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00:22:49.809 --> 00:22:50.910
It was great to have it.
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00:22:50.910 --> 00:22:54.609
I thought mine looked all right, you know, but it's
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no great loss.
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To bring this to a head, a recent review paper
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found that there wasn't hard evidence to support the idea
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that circumcisions make sex worse for men. Certainly, millions of
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circumcised men around the world still really, really enjoy sex.
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That's not the case for everyone, though. During Carolyn's research
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on circumcisions, she found a group of people who have
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real issues with their circumcised penises.
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I did come across some people who actually seemed very
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traumatised by their lack of foreskin.
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Some of them told Carolyn that they were upset that
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something important to them had been removed from their body
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and they didn't have any choice in it. Some blamed
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their long-lost foreskins for a lack of sexual confidence or
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for their body issues. So when you put it all together,
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do you think that being intact increases your chance of
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having better sex?
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Well....
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I think that it doesn't usually matter, but when it matters,
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00:23:59.319 --> 00:24:03.240
it matters a lot. So most people with penises don't
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care about their circumcision status. They don't spend a lot
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00:24:05.859 --> 00:24:10.069
of time thinking about it. But if their circumcision status
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00:24:10.130 --> 00:24:13.829
does matter to them, it is part of their identity
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and it can affect their sexual pleasure in a way
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that is damaging.
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Conclusion.
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As best as science can tell, a circumcision does not
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make a penis less sensitive and it's unlikely to affect
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00:24:26.960 --> 00:24:30.809
a man's sex life in a big way. Still though,
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00:24:30.960 --> 00:24:34.190
for a small group of men, they take their circumcisions
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really hard. And then it does affect their sex life.
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00:24:38.930 --> 00:24:42.950
So when it comes to circumcisions, do they stack up? One,
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are there risks to this surgery? Well, it can be
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painful and there can be serious complications.
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But they are very rare. Two, does it reduce your
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risk of infections?
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Yes.
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For babies, it cuts down the risk of UTIs, but
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that's a rare disease anyway. And when that baby grows
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up and starts getting laid, it can reduce their risk
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00:25:06.019 --> 00:25:10.589
of HIV, HPV and herpes. Three, when it comes to
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00:25:10.619 --> 00:25:13.009
men's sex life, does it put a damper on things?
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It's unlikely getting snipped plays a huge role in sexual
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pleasure for most men.
455
00:25:20.250 --> 00:25:21.529
So what are we to make of this?
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00:25:22.259 --> 00:25:25.720
Well, when Andrew, our circumcision guru, and his team at
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the American Academy of Pediatrics wrapped up their review, what
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did they say?
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We felt that the benefits outweighed the risk enough that
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people who want it should be allowed to have it,
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should have access to it. But it doesn't have enough
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benefit to say everybody ought to have it.
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To cut to the chase?
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To be fair, the benefits are very, very modest. The
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00:25:49.619 --> 00:25:52.680
risks are very, very modest.
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00:25:53.460 --> 00:25:55.779
So to Andrew, either choice is valid.
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00:25:56.380 --> 00:25:59.099
And when he had to make the decision, it actually
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wasn't about the medical benefits.
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So I have a son. My son is 14.
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00:26:04.180 --> 00:26:06.380
When he was little, did you decide to give him
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a circumcision?
472
00:26:07.829 --> 00:26:11.329
Yes, I did decide to do a circumcision. At the
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time I did it, I didn't feel like I was
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00:26:13.230 --> 00:26:17.150
doing it as a doctor. I was doing it as
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a religious ceremony. You know, I'm a practicing Jew, and
476
00:26:20.950 --> 00:26:24.170
in our traditions, we do the circumcision on the eighth day.
477
00:26:24.650 --> 00:26:29.579
And how did you feel as a scientist that you
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00:26:29.619 --> 00:26:33.940
were making this big decision for your son based on religion?
479
00:26:34.619 --> 00:26:38.240
You're not one thing. So I'm not a scientist 24-7.
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00:26:38.299 --> 00:26:41.960
I mean, like all people, we're complicated. And that's why
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00:26:41.980 --> 00:26:45.220
you have to kind of respect that it's a messy decision.
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00:26:45.740 --> 00:26:47.420
And we want to try to make this a black
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00:26:47.440 --> 00:26:50.640
and white decision where you just, you know, you punch
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00:26:50.660 --> 00:26:53.269
a bunch of numbers in the computer and you spit
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00:26:53.309 --> 00:26:56.009
out the right answer. But it's not that way. It's
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00:26:56.049 --> 00:26:56.960
a messy decision.
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00:26:58.190 --> 00:27:01.710
Andrew says Americans should just get used to the idea
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that there will be different kinds of penises.
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00:27:04.650 --> 00:27:06.269
In fact, he envisions a.
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00:27:06.369 --> 00:27:11.500
World, a better world, a beautiful world. where every sort
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00:27:11.519 --> 00:27:13.640
of penis has its place in the rainbow.
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00:27:14.019 --> 00:27:16.640
Why do all penises have to look alike? Why can't
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00:27:16.869 --> 00:27:18.849
some people do one thing and some people do another
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00:27:18.890 --> 00:27:22.589
and let families do what they feel is best for them?
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00:27:26.910 --> 00:27:27.349
Someday.
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00:27:27.369 --> 00:27:27.470
Maybe.
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00:27:28.650 --> 00:27:28.950
Maybe.
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00:27:42.660 --> 00:27:44.490
That's science versus circumcisions.
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00:27:48.829 --> 00:27:49.190
Great.
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00:27:49.329 --> 00:27:52.210
Those are our only questions. Is there anything you wanted
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00:27:52.230 --> 00:27:52.609
to add?
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00:27:52.769 --> 00:27:55.809
To anyone out there, if you have any comments or
503
00:27:55.910 --> 00:27:59.990
concerns about anything I've said, please send your email to
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00:28:00.150 --> 00:28:01.740
science versus....
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00:28:04.200 --> 00:28:07.599
Sorry, there's something wrong with the connection here. We're going
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00:28:07.619 --> 00:28:08.599
to have to leave you there.
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00:28:13.880 --> 00:28:16.089
We have a big favour to ask. If you listen
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00:28:16.119 --> 00:28:19.190
to Science Versus, even just every now and then, we'd
509
00:28:19.309 --> 00:28:21.769
love for you to fill out a survey. We want
510
00:28:21.789 --> 00:28:23.809
to know what you like about the show, what you want.
511
00:28:23.730 --> 00:28:26.410
More of, what you want less of. Tell us.
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00:28:26.750 --> 00:28:35.390
Go to scienceversus.show slash survey. That's scienceversus, sciencevs.show slash survey.
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00:28:35.670 --> 00:28:38.519
Thank you. and Bahizi Ignatius.
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00:29:06.680 --> 00:29:09.960
For this episode, we also spoke to Dr. Jen Bossio, Dr.
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00:29:10.059 --> 00:29:13.240
Aaron Tobian, and a bunch of folks at the CDC.
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00:29:13.640 --> 00:29:14.819
Thank you so much.
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00:29:15.400 --> 00:29:18.079
A special thanks to the parents and circumcised men.
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00:29:17.960 --> 00:29:20.369
Who spoke with us for this story, as well as
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00:29:20.440 --> 00:29:24.049
Frank Lopez, and to all my family and Joseph Lavelle Wilson.
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00:29:25.109 --> 00:29:27.650
We're off next week, but we'll be back in two weeks,
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00:29:27.890 --> 00:29:30.190
and then we're tackling Lyme disease.
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00:29:30.769 --> 00:29:32.150
Should you be afraid of it?
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00:29:32.549 --> 00:29:34.890
Physicians don't want, they don't want to go near these patients.
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00:29:35.759 --> 00:29:37.319
The patients are regarded as lepers.
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00:29:38.480 --> 00:29:39.630
They don't want to go near them with a 10.
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Pole.
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I'm Wendy Zuckerman. Back to you next time.
